Identifing and Priority Setting of Barriers to Evidence-Based Practice: A Multimethod study

Abstract

English Abstract Introduction: Evidence-Based Practice (EBP) has been introduced as an approach to evaluate treatment and patient care and means combining the best available evidence with clinical experiences, values and expectations of patients. Evidence show that there are barriers to the implementation of EBP. Therefor this study aims to identify and prioritize barriers to evidence-based practice. Method: This study was performed in three general stages. In the first stage, a systematic review of published studies after 2014 was conducted. The required information was collected by searching for relevant keywords in databases. After carefully reviewing the titles and abstracts of the articles, items that had a weak relevance to the objectives of the study were removed. After careful study and extraction of the required information, the extracted results were first summarized in the extraction table. In the second stage, to identify new barriers, as well as to identify solutions to overcome these obstacles from the perspective of 123 national and international experts in the field of EBP, an open-ended questionnaire was used. Questionnaires were sent to individuals via email. In the third stage, after merging the results of the first and second stages and finalizing the list of barriers, based on four criteria of importance, improvability, cost-effectiveness and urgency, barriers were given a score of one to four. EBP barriers were identified in the form of prioritization matrices, according to experts in the field of EBP. The results were analyzed in SPSS 25 software by relevant statistical tests (T-Test and One-Way Anova). Results: Finally, 77 articles were included in the study. Extracted barriers were divided in 5 areas of specialized / hospital care (50 studies and 67% barriers), primary health care (5 studies and 6% barriers), rehabilitation care (11 studies and 11% barriers), medical education (5 studies and 5% of barriers), and health management and decision making (6 studies and 12% of barriers). Lack of time (80 times), lack of support (70 times) and inadequate skills (63 times) had the highest repetition. After summarizing the results of the open-ended question and removing duplicates and categorizing and coding the mentioned barriers and solutions, 45 barriers were divided into 9 groups and 41 solutions into 6 groups. These barriers were grouped into organizational barriers, training barriers, evidence-related barriers, individual barriers, knowledge translation barriers, resource barriers, political barriers, organizational culture barriers, and unfamiliarity with the concept of EBP. The mentioned solutions to remove the obstacles were placed in the groups of educational solutions, political solutions, system level solutions, evidence improvement solutions, EBP implementation strategies and EBP promotion. According to experts, barriers to skills shortages, poor education and low knowledge with scores of 2.96, 2.85 and 2.87 (out of 4 )had the highest priority, respectively. Significance and necessity criteria were significantly different between men and women (P-value <0.05). There was a significant difference (P-value <0.05) between scores of all four criteria in division of income between different countries. The results of Pearson correlation test showed that age had an inverse and weak relationship with all four criteria, which was significant in terms of urgency and importance. There was a significant inverse relationship between income (GNIPC) and priority scores of research barriers, inadequate skills, inadequate access, inadequate education, low participation, negative attitude, poor motivation, poor support, structural barriers and language barriers (P-value <0.05). Conclusion: In this study, the results of the previous review study were updated and updated barriers were identified, categorized, prioritized and analyzed, so it can be used as a practical guide to expand and improve evidence-based performance by policy makers and managers and remove barriers, especially in middle and low income countries.